Objectives: The accurate diagnosis and prognostic assessment of Critically ill patients with pneumonia remain challenging, necessitating the evaluation of multiple biomarkers to enhance clinical decision-making. This study aimed to investigate the diagnostic and prognostic value of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), selenium, lactate, soluble urokinase plasminogen activator receptor (suPAR), and peptidyl arginine deiminase 2 (PAD2), and to determine their associations with disease severity and mortality. Methods: A prospective observational cohort study was conducted on 130 critically ill pneumonia patients and 45 non-critically ill outpatient controls. Biomarker levels were assessed using ELISA, PCR, and standard biochemical assays, and correlated with severity indices and clinical outcomes. Results: Lactate, PCT, CRP, IL-6, and PAD2 levels were significantly elevated in patients versus controls (p < 0.001), with higher levels observed in non-survivors (p < 0.001) except for PAD2 levels were not significantly associated with survival status (p = 0.346). Although suPAR and selenium differed between patients and controls, they did not distinguish survivors from non-survivors. suPAR correlated positively with PCT, while PAD2 showed significant associations with inflammatory markers and severity scores. No biomarker demonstrated superior prognostic accuracy. Conclusion: Lactate, PCT, CRP, IL-6, and PAD2 exhibit diagnostic relevance in pneumonia. Several biomarkers, including IL-6 gene expression, IL-6, CRP, PCT, and lactate, demonstrated excellent prognostic discrimination (AUC >0.95). However, comparative ROC analysis revealed no statistically significant superiority of any single biomarker over the others, suggesting that a multimarker approach may provide greater clinical value than reliance on an individual marker.
Background: Unplanned extubation (UE) is a critical adverse event in the intensive care unit associated with significant morbidity. This study aimed to evaluate the incidence, clinical characteristics, and 28-day mortality predictors of UE in a large tertiary care setting. Methods: A two-year retrospective descriptive study was conducted in a 120-bed closed ICU in Riyadh, Saudi Arabia, between January 2024 and December 2025. All adult patients undergoing mechanical ventilation who experienced UE were included. Data on demographics, airway management, staffing ratios, and clinical outcomes were analyzed. Results: Out of 4,054 mechanically ventilated patients, 226 experienced UE, resulting in an incidence rate of 0.52 per 100 ventilator days. The majority of events were self-extubations (77.4%) and occurred during the day shift (61.5%). The median (IQR) distance from the endotracheal tube (ETT) tip to the carina was 6.2 (4.6 – 7.8) cm, indicating relatively superficial positioning. Re-intubation was required in 57.5% of cases within 48 hours. The overall 28-day mortality rate was 22.6%. Accidental extubation patients were more frequently reintubated (90% vs. 48%) and had a higher 28-day mortality rate (44% vs. 16.6%). Subgroup analysis revealed that younger age (≤39 years; RR 0.35), occurrence during the day shift (RR 0.56), successful avoidance of re-intubation (RR 5.54 if reintubation required), and self extubation (RR 2.66 if accidental) were significantly associated with lower mortality risk. Conclusion: While the incidence of UE was relatively low, the high rate of self-extubation during peak activity hours (day shifts) and the superficial positioning of ETTs suggest a need for enhanced tube fixation and vigilance during sedation holidays. Younger age, morning shift occurrence, avoiding the need for re-intubation, and self-extubation are key factors associated with improved survival following an unplanned extubation event.
Introduction: Intensive Care Units (ICUs), though comprising a small proportion of total hospital beds, represent a disproportionately high share of healthcare expenditure. Accurate cost assessment is vital for optimizing resource allocation, particularly in resource-limited settings like Greece. Aim of the study: To estimate the direct cost of ICU hospitalization in adult patients using a micro-costing approach and to identify clinical and organizational factors driving these costs. Material and Methods: A prospective surveillance study was conducted over two years in four multidisciplinary adult ICUs in the Attica region. Detailed patient-level data on demographics, clinical status, interventions, and resource use were collected daily. Direct ICU costs, both fixed and variable, were calculated from the hospital perspective using a bottom-up micro-costing approach. Multivariable linear regression was used to identify independent predictors of ICU costs. Results: The analysis included 500 patients, representing 12,689 patient-days. The total hospitalization cost was 6.33 million euros. The median cost per ICU admission was 7,756.8 euros, with variable costs comprising 72.5% of total expenditures. Antibiotics accounted for nearly 50% of variable costs. Significant independent cost drivers included blood transfusion (additional 2,063 euros), prolonged ICU stay (each day added approximately 264 euros), ventilator-associated events (+2,374 euros), central line-associated bloodstream infections (+1,877 euros), surgical site infections (+6,609 euros), and patient-to-nurse ratios >2 (+5,000 euros). Conclusions: ICU costs are shaped not only by patient severity and interventions but also by modifiable structural factors such as infection rates and staffing ratios. Investments in infection prevention, evidence-based transfusion practices, and adequate nurse staffing could yield substantial cost savings while improving patient outcomes in Greek ICUs. These insights provide critical, evidence-informed guidance for strengthening critical care in resource-limited settings. ?
Background: Arterial blood gas (ABG) analysis is rapidly available in emergency and intensive care settings and constitutes a core component of many critical illness scoring systems. Although ABG parameters are incorporated into many multidimensional critical illness scoring systems, their independent contribution to mortality prediction remains uncertain because these variables may change rapidly during the early course of critical illness and resuscitation. This study evaluated the prognostic performance of ABG parameters and validated severity scoring systems for predicting 28-day mortality in critically ill patients admitted from the emergency department (ED) to the intensive care unit (ICU). Methods: In this prospective observational cohort study, 242 adult patients admitted from the ED to the internal medicine ICU between January 2012 and March 2013 were enrolled. Admission ABG parameters (pH, PaCO₂, PaO₂, and HCO₃⁻) and severity scores (APACHE II, APACHE IV, and SAPS II) were recorded. The primary outcome was 28-day all-cause mortality. Prognostic discrimination was assessed using receiver operating characteristic (ROC) curve analysis. Results: Overall 28-day mortality was 47.1%. Non-survivors had significantly higher APACHE II, APACHE IV, and SAPS II scores than survivors (all p < 0.001). SAPS II demonstrated the best prognostic performance (AUC 0.720; 95% CI 0.659–0.776), significantly outperforming APACHE II and APACHE IV. In contrast, none of the individual ABG parameters independently predicted 28-day mortality (all p > 0.05). Conclusions: Multidimensional severity scoring systems, particularly SAPS II, provide superior prognostic discrimination compared with isolated ABG parameters in critically ill ED patients. Although ABG analysis remains essential for acute physiologic assessment, isolated blood gas variables appear insufficient as standalone mortality predictors in heterogeneous ICU populations.
Background: GLOBOCAN estimates that cancers such as gastric (mortality rate of 8.2%), pancreatic (4.5%), hepatic (8.2%), and colon (5.8%) are a significant public health burden for most countries. Literature is limited on determinants of mortality, hospital costs, and healthcare utilization among sepsis patients. This study aimed to identify the outcomes of sepsis in gastric, colon, hepatic, and pancreatic cancers in the United States. Methods: We conducted a retrospective analysis using the National Inpatient Sample Database (2017-2021) using ICD-10 codes. Adults over the age of 18 years with malignancies were included. Confounding was reduced by propensity matching and multivariate regression. A p-value of ≤0.05 was considered significant. Results: The prevalence of sepsis in gastric, colon, hepatic, and pancreatic cancers was 13.79%, 12.6%, 18.76%, and 19.22%, respectively. The mortality rates of each malignancy were higher in those with sepsis compared to those without sepsis (23.57% vs. 5.09%, 17.72% vs. 2.74%, 22.34% vs. 6.22%, and 17.26% vs. 5.11%, respectively). The mortality rate of each malignancy among patients requiring ICU level of care was 70.28%, 70.88%, 72.97%, and 67%, respectively. In all four malignancies, acute kidney injury, acute respiratory failure, invasive ventilation, disseminated intravascular coagulation, and shock were common factors associated with increased mortality (p<0.05). These patients incurred higher hospital charges and experienced longer hospital stays than compared to those without sepsis (p<0.001). Conclusion: Our analysis revealed that patients with gastrointestinal malignancies experience high mortality rates when affected by sepsis, with acute organ dysfunction and the need for ICU-level care identified as key predictors of poor outcomes. This emphasizes the need for tailored management strategies to improve survival outcomes. Future studies should focus on treatment perspectives and guideline-directed therapies.
